neurology

Question 1

Which anti-epileptics can reduce the efficacy of the OCP?

Answer 1

The enzyme-inducing antiepileptic drugs are carbamazepine, oxcarbazepine, perampanel (at doses of 8 mg daily or more), phenobarbital (phenobarbitone), phenytoin, primidone and topiramate (at any dose).

Question 2

What features would suggest an alternative diagnosis to Parkinsons?

Answer 2

Consider an alternative diagnosis if:

early dementia
early falls
early severe autonomic dysfunction
other neurological signs (UMN, abnormal eye movements, cerebellar sings)
symptom onset with dopamine antagonists
no response to large doses of levadopa
Hx repeated strokes with stepwise progress of Parkinsons features

Question 3

What are the recommendations to avoid analgesia withdrawl headaches?

Answer 3

Limit nonopioid analgesia to <15 days a month, and triptans to <10 days a month

Question 4

WHat frequency of migraine attacks would lead you to consider prophylaxis?

Answer 4

> 2-4 days a month

Question 5

Lifestyle measures to avoid migrianes include?

Answer 5

regular sleep
steady BGL
hydration
min caffeine
exercise
regular relaxation technique
avoid triggers

Question 6

Simple migraine analgeisa includes?

Answer 6

soluble aspirin 900-1000mg PO, repeat dose 4-6 hours later. MAx 4g 24 hours

ibuprofen 400-600mg , rpt 4-6 hrs. Max 2.4 g 24 hours.

Question 7

If simple analgesia fails for migriane attacks, what can you consider?

Answer 7

eletriptan 40-80mg, rpt 2 hours later. Max 160mg/24 hs

naratriptan 2.5mg, rpt 4 hrs. max 5mg/24hrs

plus many more triptans

Question 8

migraine in pregancy treatment

Answer 8

soluble paracetamol 1g, rpt dose 4-6 hours, max 4g/24 hrs

if severe and refractory prednisolone 50mg OD for 2 days.

Question 9

Define statas migrainous, and how do you treat it?

Answer 9

Lasts >72 hours

sumitriptan 6mg s/c (provided no other tripatans in last 2 hours)

Question 10

Migraine prophylaxis drugs and duration?

Answer 10

8-12 weeks

amitriptyline or notriptyline 10mg OD nocte, increasing by 10mg weekly, max 75mg

or

candesartan 4mg OD, increasing weekly by 4mg, max 32mg (esp if obese/diabetic)

or

propanolol 20mg nocte, inc weekly, max 160mg in 2-3 divided doses.

Question 11

Mentrual migraine prophylaxis

Answer 11

ibuprofen 400 mg orally, 3 times daily for 5 to 7 days, starting 2 to 3 days before menses are due
OR

naproxen modified-release 750 mg to 1 g orally, once daily for 5 to 7 days, starting 2 to 3 days before menses are due
OR

naratriptan 1.25 to 2.5 mg orally, twice daily for 5 to 7 days, starting 2 to 3 days before menses are due.